Osteochondral Lesions

Osteochondral Lesions: Microfracture vs Reconstruction

Mechanism of Injury

Osteochondral Microfracture

  • Osteochondral lesions can be treated by Microfracture or by Allograft Reconstruction for larger lesions
  • Occur as a result of ankle sprains and fractures
  • Ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT
  • Ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT

Allograft Reconstruction of OCL

Requires live allograft donor tissue and a medial malleolar osteotomy of the ankle

Advanced Reconstruction

Osteochondral lesion (OLT) Micro Fracture vs Reconstruction
Post Operative Instructions


  • You will have a plaster cast on your ankle and foot for 2 weeks following surgery
  • An aircast will be applied at 2 weeks
  • If you have a MICROFRACTURE you will begin WB at 2 weeks
  • At 6-8 weeks, you will begin walking on the aircast if you have a RECONSTRUCTION and at 12 weeks the aircast will be removed


  • The surgical incision has been closed with sutures
  • Do not get the cast or wound wet for the first two weeks. When showering place a bag over the cast and secure with tape to your leg to avoid the cast and wound getting wet
  • Stitches will be removed at your 2 week appointment
  • After the stitches are removed, you may begin to shower after 2-3 days
  • Do not immerse the foot in water (bath, hot tub, pool) for 4 weeks
  • Do not apply any lotions or creams on the wound for 6 weeks

Weight Bearing:

  • You will be non weight bearing for 2 weeks with a MICROFRACTURE
  • You will be non weight bearing for the first 6 weeks while in an aircast following a RECONSTRUCTION
  • You will use a mobility device to offload your foot (crutches, walker, stirrup cast)
  • After 6-8 weeks you may begin fully walking on the foot with a RECONSTRUCTION


  • You will be given a prescription for pain medication
  • Pain medication should be used regularly for the first 24-48 hours, when required for the first 1 to 2 weeks, followed by Regular ibuprofen
  • Aspirin may be prescribed as a blood thinner


  • For right foot surgery you are not permitted to drive until you have completely weaned off the aircast
  • For left foot surgery, please contact your insurance company to see if you are permitted to drive
  • Driving is not permitted while on narcotics


  • Two weeks off work is recommended for initial recovery
  • If you can be transported to work and you have a sedentary occupation you may return to work when you are able and are off narcotics
  • From 2-8 weeks sedentary duties is recommended
  • By 12 weeks you can gradually return to full duties
  • If your job is physically demanding, return to full duties is usually possible around 12 weeks post operatively

Follow Up:

  • You will have your first appointment 2 weeks after surgery in the Fracture Clinic
  • Your next appointments will be at 6 weeks, 3 months then 6 months post operatively


  • It is normal to experience mild to moderate pain, numbness, or tingling for the first 2 weeks following surgery
  • You will get back to most of your activities by 6-12 months
  • Swelling often remains for 6-12 months
  • You are expected to experience a FULL recovery (no pain, no swelling, ability to walk, etc.) in 9-12 months